Diagnosis of myopathies using histology, histochemistry, immunohistochemistry and electron microscopy: a single center experience

Skeletal muscle biopsy is important for the diagnosis of motor unit disorders, systemic diseases and metabolic disorders. In some cases, routine histopathologic methods are not conclusive and histochemistry, immunohistochemistry and even an electron microscopic study are required. In this study, we describe our experience in the diagnosis of myopathies, considering all of the above-mentioned methods. During a period of 18 months, 43 specimens of patients with the impression of myopathy were submitted to the Pathology Department and were evaluated with H and E and histochemical stainings [PAS, Oil red O, ATPase, NADH-TR, Gomori Trichrome], immunohistochemistry [IHC] for dystrophin and electron microscopy. Three specimens were excluded from the study because there were only adipose tissues and no adequate muscle was present for evaluation. Twenty three [57.5%] males and 17 [42.5%] females with a mean age of 34 years were evaluated. The results were as follows: Becker's muscular dystrophy [5 cases, 12.5%], Duchenne's muscular dystrophy [3 cases, 7.5%], fascioscapulohumeral dystrophy [3 cases, 7.5%], limb girdle dystrophy [2 cases, 5%], polymyositis [6 cases, 15%], dermatomyositis [2 cases 5%], McArdle's disease [1 case, 2.5%], hypothyroidism myopathy [1 case, 2.5%], type 2 atrophy secondary to drugs and systemic diseases [2 cases 12.5%], congenital myopathy [2 cases 5%], McArdle [1 case 2.5%], unclassified myopathy [2 cases, 5%], and normal muscle biopsy [8 cases, 20%]. Although a genetic study was not available to confirm the diagnosis of cases such as fascioscapulohumeral myopathy, the diagnosis was made after putting all of the findings together including clinical presentation, family history, NCV, EMG, etc. In the cases with no definite diagnosis by the histology, histochemistry and IHC, we should perform an EM study to find out the distinct ultra-structural changes which can be diagnostic for some muscle disorders. EM study in conjunction with light microscopy of muscle biopsy could be very helpful in establishing the diagnosis of some types of myopathies

Tramadol induced seizure: report of 106 patients

Seizure is one of the possible adverse effects of tramadol hydrochloride, a synthetic, centrally-acting analgesic, prescribed for the treatment of moderate to severe pain. In this study, we describe 106 patients with tramadol induced seizures. The patients, who were referred to Nemazee Hospital, Shiraz, Iran, from March 2006 to March 2008, were examined in this cross-sectional study. All of the patients had experienced seizure[s] after ingesting tramadol. Each patient was interviewed for demographic data, history of epilepsy, family history of epilepsy, duration of tramadol use, total dose and the last dose of ingested tramadol. Neurological examinations, routine laboratory tests, electroencephalography, and brain computed tomography were performed for each patient. One hundred and six patients were studied [102 males and 4 females, mean age: 26.7 +/- 6 g years]. Among them, 92 [86.8%] had new-onset provoked seizure[s] induced by tramadol and in 14 patients [13.2%], tramadol ingestion was considered as a precipitating factor in the setting of previously-known epilepsy. Tramadol was prescribed by the physicians for alleviation of pain in 20 patients [18.9%] and abused in the remainder [86 patients, 81.1%]. The dose of ingested tramadol before the seizure[s] was 50 to 1500mg. Tramadol may provoke seizures in patients with epilepsy and also in previously healthy people even within the recommended dose ranges. Because most of the cases had occurred in young abusers, strategies to prevent tramadol addiction should be sought

Psychometric evaluation of patients with behget's disease

Behget's disease is a vasculitis with multi-organ involvement. Our knowledge of the psychological aspects of Behget's disease is very limited. 40 women and 24 men who fulfilled the International Study Group [ISG] criteria of Beliefs disease were selected from Beliefs Disease Clinic of Nemazee Hos-pitaK Shiraz, South of Iran. Controls consisted of 65 healthy volunteers. Both patients and controls completed SCL-90R questionnaire. Scores of somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideations and psychoticism were compared between cases and controls. Patients with Behcet's disease had significantly [P=0.04] higher global severity index of SCL-90R in comparison to controls. The patient group also had significantly higher scores for aggression [P=0.03], anxiety [P=0.04] and somatization [p=0.00] than controls. It is concluded that SCL-90R is a useful tool for evaluation of the psychiatric status of patients with Beliefs disease

Amyotrophic lateral sclerosis in a patient with Behcet's disease

Behcet's disease is a multisystem vasculitis. Its neurological involvement mostly includes parenchymal and nonparenchymal central nervous system manifestations. Peripheral nervous system presentations are rare. A 32-yr-old male patient who fulfilled the international study group criteria for Behcet's disease, referred to our center with walking difficulty and repeated falling downs. Neurological examination revealed weakness, wasting and fasciculation of distal muscles associated with corticospinal signs. Neuroimaging data were insignificant but electrodiagnostic studies were in favor of motor neuron disease. To best of our knowledge, this is the first report of association of amyotrophic lateral sclerosis [ALS] and Behcet's disease